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Special coverage: Medicare

Nov. 15: Now what?

If nothing else, Congress has created a raft of new choices for people on Medicare. Here are step-by-step recommendations to help you navigate the new drug maze.

By STEVE NOHLGREN
Published October 30, 2005

	[Times photo: Ted McLaren]
	Clearwater residents Dorothy and John Ravener figure they don’t need a Medicare drug plan because a health plan from his his union, the International Longshoreman’s Association, gives them a three month’s supply of drugs for a $10 copayment. “We wouldn’t be able to afford it, if it wasn’t for that drug plan,” she says. “Either that or I’d have to get really healthy in a hurry.”

Step 1: HMO vs. traditional Medicare

Medicare HMOs generally offer doctor and hospital services that cost less than than traditional Medicare, though you usually must stick to the doctors and hospitals on an HMO network. They are also an inexpensive way to get prescription drugs because many do not charge an extra monthly premium.

If you are comfortable with an HMO or other network-type program, go to steps 7-9, which compares the HMO plans in the Tampa Bay area.

If you prefer traditional Medicare's Part A and Part B, where you pick your own doctors and hospitals, proceed to Step 2.

If you previously joined an HMO primarily to get drug coverage, Medicare's new rules now give you a chance to return to traditional Medicare and pick up drug coverage with a standalone Part D (prescription drug) plan. Keep in mind that with traditional Medicare, you may need to buy a supplemental policy.

If you are unsure whether you want traditional Medicare or an HMO, measure the cost of traditional Medicare by following steps 2 through 6.

Do not enroll in both an HMO and a drug plan.

Step 2: Check any existing drug coverage

If you already have good drug coverage through a former employer or union, you probably should keep that coverage if it is deemed "creditable," which means its benefits are at least as good as Medicare Part D.

Your former employer or union is supposed to notify you whether or not your current plan is "creditable." If you have not been notified, contact them. Tricare, VA and Federal Employee Health Benefits coverage are all creditable plans.

If your plan is not creditable, you probably should switch to an HMO or a Part D drug plan; that's because you will have to pay a premium penalty if you want to switch later, even if it's because your employer drops coverage.

If you get your drugs free from the manufacturer through a prescription assistance program, you probably should sign up for a Part D plan. Those aid programs may end for people on Medicare once the drug benefit starts in January.

Step 3: What if I have no coverage?

Anyone without current coverage probably should enroll in an HMO or Part D plan - even if your health is good and you never need to use it. Plans can cost less than $132 a year, a small price for protecting yourself against a sudden, expensive illness. Also, if you reject drug coverage now, you will pay a substantial premium penalty if you want to join later.

If your income and assets are limited, you should consider joining a Part D drug plan.

Step 4: Compare drug plans

The charts on the following pages can give you a general idea of what different plans cost. You must factor in the monthly Part D premium, which you will pay in addition to the Part B premium that Medicare takes out of your Social Security check. You must also add in any annual deductible and copayments. Most plans also require you to pay 100 percent of all drugs in the "coverage gap," which starts when annual drug costs hit $2,250 and ends when they reach $5,100. Above $5,100, your plan re-establishes coverage at little cost to you. If consulting the chart makes your head spin, proceed immediately to Step 5.

Step 5: Consult Medicare

No matter what else you do, do not skip this step. Medicare has a service called Drug Plan Finder, which takes a list of your medications, runs it through Medicare's computer and spits out your total cost under each of Florida's standalone plans. That will help you decide which plan is best for you.

You can operate the Drug Plan Finder yourself by visiting www.medicare.gov or you can call toll-free 1-800-633-4227 and talk to a live person who can do it for you. Remember to make a list of your medications and have it ready before you make the call. If the Web site does not let you compare drug prices immediately, try again in a few days. Medicare is still tweaking the information, but promises that it will all be in place well before signup begins on Nov. 15.

Step 6: Three key questions

Before you sign up with any drug plan, make sure that:

1. It covers all the drugs you take. 2. It can be used at a pharmacy you are comfortable with (most plans work at most chain drugstores and grocery stores). 3. You can fill prescriptions in other states if you spend significant time outside Florida. Ask the company or Medicare.

The people at 1-800-633-4227 can help you answer these questions. You can also check company Web sites, call the company or ask your pharmacist.

Step 7: Sign up after Nov. 14

The signup period for HMOs and Medicare drug plans starts Nov. 15. You cannot make any choices until then. Once you have picked a plan, you can sign up by calling the company's hotline or, in some case, by visiting the company Web site.

The people at 1-800-633-4227 also can sign you up. If you enroll before the end of 2005, your coverage will start on Jan. 1 and extend through 2006. You can also sign up between Jan. 1 and May 15, but coverage will not start until you enroll.

Step 8: Change your mind?

Since these are big changes, Medicare offers a one-time chance to change your mind without penalty. If you sign up for an HMO or standalone drug plan, you can pull out or change plans any time before May. 15. After that, you are locked in for the rest of 2006. In late 2006, you can make your choice for 2007.

If you currently receive drugs through Medicaid and also qualify for Medicare, your Medicaid coverage will end Dec. 31 and the government will enroll you in a Medicare drug plan and notify you. However, you can switch to a different plan if you like. In fact, you can switch between plans every month between now and May 15. Only this Medicaid group can switch plans monthly. Others get only one chance to switch.

Step 9: Exhale

Though this seems like a lot to chew over, resist the urge to rush. The only thing you can do between now and Nov. 15 is to study which HMO or Medicare drug plan is right for you.

Even when the signup period begins on Nov. 15, you still have six weeks to make a choice without missing a single benefit. In fact, you probably should hold off calling 1-800-633-4227 for at least a few weeks. Give the people who answer those phones time to learn the ropes.

Move quickly on only one wrinkle - low-income assistance. Medicare expects an end-of-the year surge in applications, which would be good to avoid if you can.

[Last modified November 2, 2005, 11:01:43]